News feminist philosophers can use

One would have thought that it is completely obvious that babies can feel pain. Of course, it can be argued that there’s a gap between behavioural evidence and pain states. Still, isn’t that worry really just a philosophical one, as one hears doctors say?

Unfortunately, common sense appears to have failed in the case of infants and pain.

In the early 1980’s it was revealed that babies react chemically as adults do to what adults count as painful circumstances. It also turned that neonates needing surgical interventions were given NO pain relief. “Well that is completely horrible but,” one might have thought, “At least that will end now.”

No such luck. Recent brain scanning experiments show that even very young babies do indeed react much as adults do to what adults count as painful circumstances, but pain relief is not the norm.

The brains of babies ‘light up’ in a very similar way to adults when exposed to the same painful stimulus, a pioneering brain scanning study has discovered. It suggests that babies experience pain much like adults. As recently as the 1980s it was common practice for babies to be given neuromuscular blocks but no pain relief medication during surgery. In 2014 a review of neonatal pain management practice in intensive care highlighted that although such infants experience an average of 11 painful procedures per day 60% of babies do not receive any kind of pain medication.

The study comes out of the University of Oxford. I think it applies only to the UK. There has been an earler, 2011, study in Canada covering a wider age range and the results are similarly discouraging.

In an ongoing effort to stimulate scholarship and encourage the growth of the field of feminist bioethics, the FAB Affinity Group would like to invite submissions for the American Society for Bioethics and Humanities (ASBH) 2014 Annual Meeting, October 16-19, 2014 at the Hilton San Diego Bayfront Hotel in San Diego, CA. The theme is open, but should relate to issues within feminist bioethics, broadly construed. Especially encouraged are papers that reflect works in progress, exploring new theoretical approaches to feminist bioethics or analyzing advances in the biological sciences and medicine using a feminist framework. Up to three applicants may be selected to present their work and receive feedback from the group at the Affinity Group meeting.

Abstracts or proposals (250 words or less) should be emailed to agotlib@brooklyn.cuny.edu by June 30th. Please include your full contact information. All submissions will be reviewed by the FAB Affinity Group committee. Applicants will be notified of the committee’s decision by July 31st.

Please feel free to distribute this invitation as appropriate.
Thank you, and we look forward to seeing you at ASBH in October!

This post is for those of us involved in caring for ourselves or others. (If you don’t give a sh*t about anyone, don’t read on.) It comes from a blog post by a highly credentialed physician and professor of medicine.

“DNR” is supposedly just about employing CPR. Even that was somewhat surprising, but facts about how it’s used can be very upsetting:

And it’s not just in the midst of a disaster that physicians mistake “DNR” for “Do Not Treat.” Study after study has shown that physicians say they would not administer a whole variety of treatments to patients who are DNR. One representative study of 241 physicians found that they were far less likely to agree to transfer a patient to the intensive care unit or even to perform simple tests such as drawing blood.

Most recently, physicians and nurses caring for pediatric patients also told interviewers that in practice, DNR means far more than just do not perform CPR. In this survey of 107 pediatricians and 159 pediatric nurses in a hospital setting, 67% believed a DNR order only applies to what to do after a cardiac arrest—but 33% said it implied other limitations. And 52% said that once a DNR order is in place, a whole host of diagnostic and therapeutic interventions should be withdrawn, over and beyond CPR, and a small but disturbing minority, 6%, said that a DNR order means that comfort measures only are to be provided.

Note: comment 1 below draws our attention to the possibility of state variations on a DNR order. In addition, some DNR forms are part of a living will, where you specify more about what is wanted. So it is worth checking out what is available. The focus of this post is to say ‘DNR’ may not be understood as you want it to be.

I’m reminded here of the Wiittgensteinian point that you won’t find an interpretation that won’t itself need an interpretation. That’s why at some point we need community practices.

The book apparently draws on papers from an earlier conference. Comments on Amazon make it appear as though the book is really starting up a new speciality in philosophy. And unless someone makes an effort to change things, it will quickly become an area women somehow can’t really do work in. And that is pretty serious. Why it is serious is being spelled out in the NY Times this week on “The Stone.”

She devoted lots of her time working as an advocate for the rights of people with disabilities; she worked part time as well as being heavily involved in volunteering.

She was denied a heart-lung transplant by the Stanford University School of Medicine in California because she had Down syndrome. She then (along with supporters) began a very public battle, gaining nationwide attention arguing that Down syndrome should not be enough to automatically deprive a patient of a chance to survive, this resulted in her receiving the transplant (1996).

She became the first person with Down Syndrome to ever receive a heart-lung transplant.

Jensen, an activist for disabled rights, served as president of a Sacramento disabled-rights group and was invited to watch then-President George Bush sign the Americans with Disabilities Act in 1990. Despite her disabilities, Jensen lived on her own, graduating from high school and busing tables at the Capitol cafeteria.

There doesn’t seem to be a lot of information about her or her story online, but I did find this report, which is taken from NYT and US News articles.

Suppose the problem really is in the environment, but you can medicate your child to help them cope. A lot of people may medicate themselves to help them through a bad situation. Facing an MRI in a closed machine (i.e., you’re in the clanging tunnel for possibly an hour)? Xanax can seem reasonable if you are claustrophobic. A wedding with your most difficult relatives? Maybe xanax there too, or a martini or whatever. How about a bad work situation? A pill a day to keep anger away?

For myself I’d say absolutely not in the last case (clarification added in light of comment one). For a healthy child with a poor school environment that makes concentration and learning really too hard? C/D unmedicated, A/B on pills. I feel fortunate not to have to decide this one. Some people do have tO choose between these alternatives:

CANTON, Ga. — When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.

The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”

Our posts on accepting women’s bodies of all shapes and sizes will sometimes inspire the fat police to appear to denounce any acceptance of being overweight. So I’m very happy to say that the idea that being overweight is unhealthy now has a huge question mark against it. Though we’ve heard this before, the idea is getting new attention from an August finding that even with diabetes II, being overweight can be a protection. From the NY Times:

In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease…

…. there were hints everywhere. One study found that heavier dialysis patients had a lower chance of dying than those whose were of normal weight or underweight. Overweight patients with coronary disease fared better than those who were thinner in another study; mild to severe obesity posed no additional mortality risks.

In 2007, a study of 11,000 Canadians over more than a decade found that those who were overweight had the lowest chance of dying from any cause.

To date, scientists have documented these findings in patients with heart failure, heart disease, stroke, kidney disease, high blood pressure — and now diabetes.

There are many possible explanations. One is that being overweight is often not studied independently of fitness:

The link between obesity and health derives in part from research like the Framingham Heart Study, which has followed thousands of men and women since the 1940s. But Paul McAuley, a professor of health education at Winston-Salem State University, has noted that Framingham and other longitudinal studies often fail to take into account physical activity and fitness.

Research that does tease apart weight and fitness — like a series of studies conducted by Steven Blair at the Cooper Institute in Dallas — shows that being fat and fit is better, healthwise, than being thin and unfit. Regular aerobic exercise may not lead to weight loss, but it does reduce fat in the liver, where it may do the most metabolic damage, according to a recent study at the University of Sydney.
…

The bottom line? This may be it:

In 2005, an epidemiologist, Katherine Flegal, analyzed data from the National Health and Nutrition Examination Survey and found that the biggest risks of death were associated with being at either end of the spectrum — underweight or severely obese. The lowest mortality risks were among those in the overweight category (B.M.I.s of 25 to 30), while moderate obesity (30 to 35) offered no more risk than being in the normal-weight category.

The article is interesting in another respect, as a comment on what happens to opinions that go against very established beliefs. An early article ran up against the critical review, “This cannot be true.” And as they say, it will take some time before you can expect an internist/general practitioner to accept it. It goes against the “paradigm”.

The report seems to me to have political dimensions that can pull us in very different directions. On the one hand, it still seems to me amazing to see any questioning of the idea that it is only women who face a ticking reproductive clock. On the other hand, you know that the chances are very high that there is a lot of ablest thought that the research is going to inspire, and may well have been inspired by.

Let me add in that as a parent, the thought that one’s child might not be able to earn a living is utterly terrifying. Perhaps especially in the US, the fate of at least fairly markedly neuro-atypical adults can be very awful indeed.

Having said that, let me ask that if anyone has information on what people with markedly neuro-atypical children can do to plan a safe future for the child after they have died. Supposing, that is, that they don’t want to be academics. (JOKE!)